DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20202615

An observational study to determine the status of serum and RBC folate in drug resistant epileptic children at a tertiary care centre in Western Rajasthan, India

Bindu Deopa, Bhawna Chaudhary, Ashish Gupta

Abstract


Background: Drug resistant epilepsies constitute about 10-20% of childhood epilepsies and treated with higher doses and multiple AEDs. AEDs increases folate metabolism by enzyme induction thus causes deficiency of folic acid.

Objective was to evaluate the effect on serum and RBC folate in children having drug resistant epilepsy.

Methods: In a prospective observational study 83 drug resistant epileptic children of age 6months to 180 months fulfilled the inclusion criteria enrolled in study, from Oct 2014 to Nov 2016 for a period of two years. Serum and RBC folate levels were done in these children. Epileptic children already receiving folic acid supplementation/treatment were excluded from the study. Children with serum folate level <5ng/ml and RBC folate <280ng/ml was considered as folate deficiency.

Results: Total 83 children had drug resistant epilepsy (defined by ILAE). Mean age of children with drug resistant epilepsy was 71.39±49.76 months. 71.08 % were male and 28.91% were female. Mean serum folate in these children was 7.75±2.77 ng/ml and RBC folate 381.63±164.54 ng/ml which was significantly lower as compared to healthy children or epileptic not receiving AEDs. 14.45 % children in drug resistant epilepsy had serum folate <5ng/ml while 20.89% were found to be RBC folate deficient (RBC level <280ng/ml).

Conclusions: Antiepileptic drugs are associated with lower blood folate status which deteriorates further with increasing number and doses of AEDs in drug resistant patients. Therefore blood folate monitoring should be done in all children on AEDs on regular intervals and should be considered in the etiologic differentials of drug resistant epilepsy.

 


Keywords


Drug resistant epilepsy, Folic acid, Refractory seizure

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References


Amudhan S, Gururaj G, Satishchandra P. Epilepsy in India I: Epidemiology and public health. Annals Indian Acad Neurol. 2015 Jul;18(3):263.

Gadgil P, Udani V. Pediatric epilepsy: the Indian experience. J Pediatr Neurosci. 2011 Oct;6(Suppl1):S126.

Jadavji NM, Wieske F, Dirnagl U, Winter C. Methylenetetrahydrofolate reductase deficiency alters levels of glutamate and γ-aminobutyric acid in brain tissue. Molecular Genet Metab Reports. 2015 Jun 30;3:1-4.

Baldelli E, Leo G, Andreoli N, Fuxe K, Biagini G, Agnati LF. Homocysteine potentiates seizures and cell loss induced by pilocarpine treatment. Neuromole Med. 2010 Sep 1;12(3):248-59.

Farrell CJ, Kirsch SH, Herrmann M. Red cell or serum folate: what to do in clinical practice?. Clinical Chem Lab Med. 2013 Mar 1;51(3):555-69.

Mohamad A, Mikati, Hani AJ. seizure in childhood, 1st south asia ed. South Asia: Reed Elsevier India Pvt. Ltd.; 2016.

Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010 Jun 1;51(6):1069-77.

Sener U, Zorlu Y, Karaguzel O, Ozdamar O, Coker I, Topbas M. Effects of common anti-epileptic drug monotherapy on serum levels of homocysteine, vitamin B12, folic acid and vitamin B6. Seizure. 2006 Mar 31;15(2):79-85.

Karabiber H, Sonmezgoz E, Ozerol E, Yakinci C, Otlu B, Yologlu S. Effects of valproate and carbamazepine on serum levels of homocysteine, vitamin B12, and folic acid. Brain Development. 2003 Mar 31;25(2):113-5.

Koury MJ, Ponka P. New insights into erythropoiesis: the roles of folate, vitamin B12, and iron. Annu Rev Nutr. 2004 Jul 14;24:105-31.

World Health Organization (2012). Serum and red blood cell folate concentrations for assessing folate status in populations. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/75584/1/WHO_NMH_NHD_EPG_12.1_eng.pdf Accessed 15 January 2013.

Toprak B, Yalcın HZ, Colak A. Vitamin B12 and folate deficiency: should we use a different cutoff value for hematologic disorders?. Int J Lab Hemat. 2014 Aug 1;36(4):409-14.

Linnebank M, Moskau S, Semmler A, Widman G, Stoffel‐Wagner B, Weller M, et al. Antiepileptic drugs interact with folate and vitamin B12 serum levels. Ann Neurol. 2011 Feb 1;69(2):352-9.